[Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention]. / Comentario del CEIPV a las nuevas Guías Europeas de Prevención Cardiovascular 2021.

Statement of the Spanish Interdisciplinary Vascular Prevention Committee on the updated European Guidelines on Cardiovascular Disease Prevention. We present the Spanish adaptation of the 2021 European Guidelines on Cardiovascular Disease (CVD) prevention in clinical practice. The current guidelines besides the individual approach greatly emphasize on the importance of population level approaches to the prevention of cardiovascular diseases. Systematic global CVD risk assessment is recommended in individuals with any major vascular risk factor. Regarding LDL-Cholesterol, blood pressure, and glycemic control in patients with diabetes mellitus, goals and targets remain as recommended in previous guidelines. However, it is proposed a new, stepwise approach (Step 1 and 2) to treatment intensification as a tool to help physicians and patients pursue these targets in a way that fits patient profile. After Step 1, considering proceeding to the intensified goals of Step 2 is mandatory, and this intensification will be based on 10-year CVD risk, lifetime CVD risk and treatment benefit, comorbidities and patient preferences. The updated SCORE algorithm-SCORE2, SCORE-OP- is recommended in these guidelines, which estimates an individual's 10-year risk of fatal and non-fatal CVD events (myocardial infarction, stroke) in healthy men and women aged 40-89 years. Another new and important recommendation is the use of different categories of risk according different age groups (< 50, 50-69 ≥ 70 years). Different flow charts of CVD risk and risk factor treatment in apparently healthy persons, in patients with established atherosclerotic CVD, and in diabetic patients are recommended. Patients with chronic kidney disease are considered high risk or very high-risk patients according to the levels of glomerular filtration rate and albumin-to-creatinine ratio. New lifestyle recommendations adapted to the ones published by the Spanish Ministry of Health as well as recommendations focused on the management of lipids, blood pressure, diabetes and chronic renal failure are included.

[Detection of cardiovascular risk factors in the reformed primary care network in Catalonia. Comparison between the years 1995 and 2000]. / La detección de factores de riesgo cardiovascular en la red reformada de atención primaria en Cataluña. Comparación entre los años 1995 y 2000.

OBJECTIVES: To know if much the detection and control of cardiovascular risk factors (FRCV) have been incorporated in primary care settings (PCS) on 2000 and compare them with 1995 results. Design and participants. A descriptive cross-sectional study of a random sample of 5,875 of clinical histories (CH) of patients aged 15 and over attended during 2000 in PCS, which had been in operation for over three years. MEASUREMENTS AND MAIN RESULTS: Whether were recorded values, levels, diagnoses and control related to: blood pressure, cholesterol, glucose, weight, size, tobacco and alcohol consumption, in order to compare 1995 and 2000 results obtained with the same methodology. Cholesterol levels (57.3%), blood pressure values (52.9%) and glucose levels (51.3%) are the most recorded variables in CH. Obese diabetics and high blood pressure patients are the most studied with a mean of 3.6 records in the CH related others CRF. Smoking (41.7%) and hypertension (32.9%) are the most frequents diagnoses. The 32.3% of the high blood pressure patients have optimum control and 42.9% acceptable control. The 31.2% hyperlipaemia and the 34.1% diabetic patients are controlled. Compared with 1995, the main variations observed are: an increase of the records of cholesterol levels and glucose levels and a decrease of the others, especially in tobacco and alcohol consumption screening. Diabetes and obesity diagnosis decrease and smoking and excessive alcohol consumption increase have been also observed. Screening age and sex group differences are maintained. CONCLUSIONS: The results suggest that may be a change in CRF screening performance is happening and the influencial factors would be study.

La detección de factores de riesgo cardiovascular en la red reformada de atención primaria en Cataluña. Comparación entre los años 1995 y 2000 / Detection of cardiovascular risk factors in the reformed primary care network in Catalonia. Comparison between the years 1995 and 2000

Objetivo. Conocer la detección y el control de los factores de riesgo cardiovascular (FRCV) en las áreas básicas de salud (ABS) en el año 2000 y compararlos con resultados de 1995.Diseño y sujetos. Estudio descriptivo, transversal, de una muestra de 5.875 historias clínicas (HC) de la población de 15 y más años atendida en las ABS de Cataluña con más de 3 años de funcionamiento.Mediciones y resultados principales. Se estudia el registro en la HC de los valores, diagnóstico y control en relación con: tensión arterial, colesteremia, glucemia, talla, peso, hábito tabáquico y consumo de alcohol. Se comparan los resultados con los obtenidos en el estudio de 1995, realizado con la misma metodología.Las variables clínicas más anotadas son colesteremia (57,3 por ciento), tensión arterial (52,9 por ciento) y glucemia (51,3 por ciento). Los obesos diabéticos y los hipertensos son los pacientes más estudiados, con una media de 3,6 anotaciones en la HC sobre otros factores de riesgo. El tabaquismo (41,7 por ciento) y la hipertensión arterial (32,9 por ciento) son los diagnósticos más frecuentes.Se observa un control óptimo y aceptable en un 32,3 por ciento y 42,9 por ciento de los hipertensos, respectivamente. El 31,2 por ciento de los hipercolesterémicos y un 34,1 por ciento de los diabéticos se encuentran en situación de control. Respecto a 1995 se observa un aumento de la anotación de los valores de colesterolemia y glucemia y un descenso del resto, y es especialmente relevante el del cribado del hábito de fumar y consumo de alcohol. También se constata un descenso en el diagnóstico de diabetes y obesidad y un aumento del de tabaquismo y consumo excesivo de alcohol. Se mantienen las diferencias en el cribado según grupo de edad y sexo.Conclusiones. Los resultados sugieren que puede estar produciéndose un cambio en la práctica de la detección de FRCV y cabe plantearse los factores que pueden influir en él (AU)

East-west differences in reported preventive practices. A comparative study of six European areas of the WHO-CINDI programme.

BACKGROUND: Differences have been reported in life expectancy and mortality between Eastern and Western European countries. Also, disparities have been found among different European countries or populations concerning the implementation of preventive practices by health professionals. This study analysed the patterns of reported preventive practices in three Eastern European areas and three Western ones. METHODS: Health surveys were carried out in particular geographical area of six countries participating in the project (three Eastern European countries; Russia, Poland and Hungary and three Western European countries; Finland, Germany and Spain). All of them are partners in the WHO-CINDI (Countrywide Integration Non-communicable Diseases Intervention) Programme. Three preventive practices are analysed: reported blood pressure and blood cholesterol measurements and reported antismoking counseling during the last year. Data are presented separately for the general population and for people reporting specific chronic conditions (cardiovascular disease, respiratory disease and/or diabetes mellitus). RESULTS: Blood pressure measurement and antismoking counseling are more frequently reported to be carried out by primary health care physicians in the Eastern European areas while blood cholesterol measurement is more frequently reported in Western European countries. All these preventive activities are more frequently reported to be done among people with chronic conditions than in the population as a whole. CONCLUSIONS: Major differences have been found in reported preventive practices between Eastern and Western European countries. Great potential exists for chronic disease prevention among them.

[Prevalence and factors associated to the presence of fatty liver in apparently healthy adult men]. / Prevalencia y factores asociados a la presencia de esteatosis hepática en varones adultos aparentemente sanos.

BACKGROUND: Alcohol intake in one of the factors associated with fatty liver, although its contribution as well as other factors have not been completely established. Therefore the aim of this study was to assess the prevalence and associated factors for fatty liver diagnosed by ultrasonography. SUBJECTS AND METHODS: 1,801 presumably healthy male workers (age range 18-60 years). A complete physical and laboratory investigations, including HBsAg and anti-HCV antibodies, a detailed interview on alcohol intake, and an abdominal ultrasound examination were performed in all cases. Diagnosis of fatty liver was based on defined ultrasonographic criteria. RESULTS: Eighty eight cases were excluded because of the HBsAg or anti-HCV positivity or incomplete ultrasonography. Among the remaining 1,713 cases, 236 (13.8%; 12.2-15.4) had fatty liver. Logistic regression analysis disclosed age (RR: 1.04; CI 95%; 1.03-1.05), ethanol intake > 40 g/d (2.19; 1.81-2.65), gamma-glutamyl-transferase > 40 U/l (3.51; 2.95-4.18), body mass index > 30 (3.87; 3.22-4.66) and glycemia > 120 mg/dl (2.69; 1.85-3.90) as the risk factors for fatty liver. Fatty liver was present in 8.8% of cases who did not have obesity, diabetes or hypercholesterolemia. When the subjects with obesity, hyperglycemia or hypercholesterolemia were excluded, regression analysis confirmed age, ethanol intake and gamma-glutamyl-transferase as independent factors associated with fatty liver. CONCLUSIONS: Age, alcohol intake, obesity, and increased serum levels of glucose, cholesterol and gammaglutamyl transferase are the main factors associated with fatty liver in presumably healthy adult men.

Pharmacoeconomic considerations in the management of hypertension.

Hypertension is highly prevalent in developed and developing countries (more than 30% of the adult population when a threshold value of 140/90 mm Hg is selected). It constitutes one of the major cardiovascular risk factors and accounts for more than 5% of total deaths worldwide. The economic impact of hypertension is enormous, representing $US23.74 billion in the US in 1995 and approximately $US1685 million in Spain in 1994. Direct costs amount to more than 50% of the total costs of hypertension, and almost 70% of these are attributable to drug treatment. Furthermore, hypertensive patients use medical services 50% more than normotensive individuals, and hypertension represents one of the 3 leading causes of visits to primary healthcare centres. When considering the cost effectiveness of hypertension treatment, there is no doubt that it is cost effective in comparison with other interventions, although some controversies exist, mainly with respect to mild-to-moderate hypertension and to the long term versus short term benefits. The controversy about the absolute risk of hypertension influences the cost-effectiveness analysis. Because of the limitations of the available cost-effectiveness analyses, it is currently impossible to recommend the use of any particular antihypertensive drug for all patients with hypertension. Consequently, the choice of antihypertensive in any patient should be guided by clinical experience and the recommendations of the present international guidelines.

Increased prevalence of type 2 diabetes mellitus and impaired glucose tolerance in first-degree relatives of girls with a history of precocious pubarche.

OBJECTIVE: To assess whether abnormal responses to an oral glucose load, dyslipidaemia and hyperandrogenaemia, which are commonly found in girls with a history of precocious pubarche, can also be detected in first-degree relatives of these patients. PATIENTS AND DESIGN: Sixty first-degree relatives (age, 41.4 +/- 4.4 years; BMI, 26.9 +/- 3.3 kg/m2) of girls diagnosed with precocious pubarche were studied. The prevalence of gestational diabetes mellitus and the hirsutism score were assessed in the females. The study was performed during the early follicular phase of the menstrual cycle in females and at random in males. MEASUREMENTS: All subjects underwent a standard 75 g 2-h oral glucose tolerance test (OGTT). Serum lipids and lipoproteins were measured in baseline blood samples in all subjects, while serum testosterone, sex hormone-binding globulin (SHBG) levels and the free androgen indices were determined only in females. Impaired glucose tolerance (IGT) and type 2 diabetes mellitus were diagnosed according to the criteria of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. RESULTS: Seven subjects (11.6%) had type 2 diabetes while a further 14 (23.3%) had IGT; prevalences significantly higher than those reported for the present population of the same age (type 2 diabetes, 2.5% and IGT, 7. 5%; P < 0.001 and P < 0.001, respectively). BMIs were similar in patients with either normal or abnormal glucose tolerance. Abnormal levels of at least two lipid parameters were found in 40% of subjects. Four out of 10 hirsute women and six non-hirsute women reported gestational diabetes. Mean serum SHBG levels were lower in female relatives compared with population controls (P < 0.0005). CONCLUSIONS: First-degree relatives of girls with precocious pubarche are at a higher risk of impaired glucose tolerance and type 2 diabetes which, in most cases, is accompanied by an unfavourable lipid profile. Hyperandrogenism and an increased prevalence of gestational diabetes mellitus are frequent among females. These data may prove useful in identifying a specific subset of the population at increased risk of developing metabolic disturbances known to predispose to cardiovascular disease.

[Determinants of quitting smoking in Catalonia, Spain]. / El abandono del hábito tabáquico en Cataluña.

OBJECTIVE: While trends in the prevalence of smoking and ex-smoking in Catalonia, Spain have been monitored, the characteristics of those smokers who quit have not been investigated. The aim of this investigation was to analyze the prevalence of cessation, or quit ratio, in Catalonia and to study its sociodemographic, life-style, and smoking correlates. SUBJECTS AND METHODS: We analyzed data collected in the Catalan Health Interview Survey conducted in 1994. This is a cross-sectional study based on a representative sample of the non-institutionalized population of Catalonia. We included for analysis a total of 5,424 subjects (3,649 males and 1,775 females) who declared to be current smokers (2,335 males and 1,331 females) or past smokers (1,314 males and 444 females). We computed the crude and age-standardized quit ratios (QR) or prevalence of cessation, as well as the odds ratio (OR) of quitting smoking, according to gender and the variables studied. RESULTS: The age-standardized QR was 31. 8% for males and 30.9% for females and increased with age. The QR was, both in males and females, greater among married subjects, with higher socioeconomic status, and with healthy life-styles (moderate and heavy leisure physical activity and moderate alcohol consumption). The OR of quitting smoking was higher in heavy smokers (OR = 2.9; 95% CI: 2.2-3.8; smokers of > 30 cigarettes/day vs. 1-10 cigarettes/day) in males, while it was < 1 for females of medium intensity, conforming a shaped curve rather than a linear trend (OR = 1.7; 95% CI: 1.0-2.9, in heavy smokers). CONCLUSIONS: This study confirms a positive association in males and females between quitting smoking and increasing age, a higher socioeconomic level, heavy smoking, and healthy life-styles. The identification of these groups should facilitate the planning of successful interventions. Further effort is also necessary to target groups with low cessation rates, such as individuals in disadvantaged social classes and light smokers.

[Public health structures in Spain: a changing panorama]. / Las estructuras de salud pública en España: un panorama cambiante.

In the last years the health care system in Spain has undergone very important transformations. However, the public health services have not followed a comparable process. Until 1979 public health structures were based in central services and their provincial units, on one side, and in the resources of local governments on the other. From then on began the process of transferring responsibilities and resources to the regional governments of Autonomous Communities (AC), which today manage most public health services, while the central government keeps as its responsibility the development of basic norms, the administration of public health services at borders and customs, and the general health coordination. The situation in 1995 resembles that of a Federal Country, although the Kingdom of Spain is not formally defined as such. The role of central government services is visibly reoriented towards coordination and the building of consensual and shared structures for health information, for need evaluation, and for policy formulation and evaluation. Although the General Health Law of 1986 considered public health as a main axis for all health agencies, its actual development has been more patchy. Several AC with an Autonomous Health Service have kept public health services separated from it. Besides, many public health functions and activities are developed today from other structures. The processes of change reveal two contradictory aspects. On one side, structures have been upgraded after decentralization, and teams reinforced, with trained and full-time staff. However, there is some dilution of public health responsibility in the periphery, and a lower visibility of the health authority.

Prevalence of diabetes in Catalonia (Spain): an oral glucose tolerance test-based population study.

The goal of this study was to investigate the prevalence of diabetes mellitus and impaired glucose tolerance in the adult population of Catalonia and study their association with obesity, central obesity, hypertension and smoking habit. A random sample of 3839 subjects aged 30-89 years participated in this cross-sectional study: 2214 subjects underwent a health examination with oral glucose tolerance test (OGTT) and 1625 were interviewed by phone. Diabetes prevalence (known and unknown) in the 30-89-year-old population was 10.3%, (95% CI: 9.1-11.6). In this age group, the prevalence rates of known diabetes, unknown diabetes and impaired glucose tolerance were 6.4, 3.9 and 11.9% in men and 6.9, 3.4 and 11.9% in women. The age adjusted prevalence to the world population for the 30-64-year-old age group was 6.1% (7.1% in men and 5.2% in women).The factors significantly associated with diabetes were age, obesity, hypertension and family history of diabetes. The high ratio of previously known diabetic cases to newly discovered ones, specially in the oldest age group, suggests good levels of awareness and medical services. The prevalence in Catalonia is similar to that observed in other Mediterranean countries.

Age at starting smoking and number of cigarettes smoked in Catalonia, Spain.

BACKGROUND: Few studies have investigated the association between age at starting smoking and the average number of cigarettes smoked per day in adulthood. To provide further evidence on this issue, we analyzed data from the Catalan Health Interview Survey (CHIS). METHODS: The CHIS was conducted in 1994 on a randomly selected sample (N = 15,000) of the population of Catalonia, Spain. A total of 4,897 current or exsmokers (3,276 males and 1,621 females) were included for analysis. Age-standardized proportions of subjects smoking <15, 15-24, and >/=25 cigarettes/day, age-standardized mean number of cigarettes smoked per day, and multivariate odds ratios (OR) of being a heavy smoker (>/=25 cigarettes/day) according to age at starting smoking (<15, 15-17, 18-19, >/=20 years) were computed. RESULTS: Men who started smoking before the age of 15 smoked on average 5.5 cigarettes more than those who started at age 19 or over. Women who started smoking early in life smoked, on average, 6.8 cigarettes/day more than women who started later. The proportion of smokers of <15 cigarettes/day was higher among subjects who started smoking later. Both for males and for females, the OR of being a heavy smoker significantly increased with decreasing age at starting smoking (OR = 2.4 for males and 4.5 for females who started at age <15 versus >/=20 years). The level of education did not modify the relationship in males, whereas the association with age at starting was only apparent for more educated women. CONCLUSIONS: This study confirms that age at starting smoking is inversely and strongly associated to the number of cigarettes smoked per day. Thus, actions aimed at the prevention or delay of smoking onset among adolescents would have an important beneficial effect.

[Renal failure secondary to diabetic nephropathy. A review of the characteristics of the diabetic patients who started dialysis in Catalonia in 1994]. / Insuficiencia renal secundaria a nefropatía diabética. Revisión de las características de los pacientes diabéticos que iniciaron diálisis en Cataluña en 1994.

The appearance of diabetic nephropathy and its progression towards renal failure can be prevented if an early treatment is instituted. However, diabetes is currently one of the main causes of entry into a dialysis program. Therefore, the diagnostic characteristics of renal disease in 105 patients who started dialysis in Catalonia in 1994 were reviewed; the presence of other changes associated with diabetes were assessed. The results showed that 81.7% of patients had proteinuria higher than 0.5 g/24 h, and 40.5% had plasma creatinine higher than 5 mg/dl at the first nephrological control. As a result, the period between diagnosis of nephropathy and the inclusion in the dialysis program was very short (3.7 years) and considerably shorter than that reflected in literature for other countries, whereas the incidence of other micro and macrovascular complications was similar. Remarkably, a high number of smokers and treatment with oral antidiabetic drugs (33%) at the end stage of renal failure was observed. These results suggest that follow-up of diabetics should be more exhaustive and serial tests be performed to detect nephropathy early. An appropriate control during renal failure stage can also postpone the disease progression and avoid the appearance of complications which at present have a high morbid-mortality and high cost.

Management of the hypertensive patient who smokes.

Smoking and arterial hypertension are highly prevalent at the community level. While the coexistence of both risk factors is less frequent, the potentiation of cardiovascular risk when both are present makes the association highly relevant in terms of a preventive approach. There are many interrelationships between smoking and high blood pressure at the clinical, epidemiological and pathophysiological levels. Those demonstrable links compel us to review the usual explanation of the influence of smoking on blood pressure. Pharmacological treatment of the hypertensive patient who smokes must be adapted to the patient's risk profile, using the most efficacious antihypertensive agents. With the exception of nonselective beta-blockers, all the available antihypertensive drugs can be prescribed. Minimal intervention and nicotine replacement constitute the most well tested interventions in helping smokers to quit their habit. Nicotine replacement is currently a well tolerated intervention, even in patients with cardiovascular disease.

Cisapride treatment changes the evolution of infant asthma with gastroesophageal reflux.

Gastroesophageal reflux has been named as a possible etiologic factor in infant asthma. We studied 28 boys and six girls aged 19.4 +/- 4.8 months whose asthma began at the age of 7.5 months (1 to 28 months). A common protocol including allergy tests and 24-h intraesophageal pH monitoring (IEpHM) was used. Patients with pathologic 24-h IEpHM were treated with cisapride while the rest were considered the control group. Symptoms score and drug consumption were evaluated in both groups, and 24-h IEpHM was repeated at 4 months. IEPHM was pathologic in 65.6% of the infants. In the cisapride group, wheezing crisis frequency decreased from 4.9 +/- 2 to 0.75 +/- 1.2 (p < 0.0002), and only 10% of patients needed basic pharmacologic treatment. The second IEpHM was normal in eight cases, pathologic in six and was not performed in seven. In the controls, wheezing crisis frequency decreased from 4.6 +/- 2.4 to 0.75 +/- 1.8 (p < 0.01), but 44% needed basic pharmacologic treatment (p < 0.05). In conclusion, gastroesophageal reflux is a frequent but not universal finding in infants with asthma; and cisapride treatment spectacularly reduces wheezing crisis frequency and antiasthmatic drug consumption in these patients.

Actions implemented to improve hypertension control in Spain.

Hypertension prevalence is estimated at approximately 30% of the adult population in Spain, using the 140/90 mm Hg cutoff. This represents a heavy public health burden when compared with other European countries, although the direct cost per person is one of the lowest in Europe. The programs implemented regionally since 1985 are presented here. As a result of them, a decade later the number of hypertensives with controlled blood pressure has increased from 10% in 1986 to 13% in 1995, and cerebrovascular mortality has steadily decreased.